Cardiac resynchronization therapy

The MATIT II trial showed a 31% reduction in all-cause mortality with ICD therapy in post-heart attack patients with an ejection fraction at or below 30%.

Patients with a specific electrical conduction delay, seen as a wide QRS on the EKG, qualify for cardiac resynchronization therapy, or CRT, a special pacemaker that helps both sides of the heart pump together.

CRT improves ejection fraction in 60 to 70% of appropriate candidates.

The goal with all four pillars is to start them as soon as possible, ideally within three months of diagnosis, and then increase the doses over weeks to months up to the target levels that have been proven to work best in the trials.

Now, Hef-Pef, the stiff heart, has been a much harder problem to solve, because for years, we simply didn't have a drug that proved benefit.

So your cardiologist might recommend a defibrillator for you.

One of the other things that we do is what's called CRT, or cardiac resynchronization therapy, meaning that it's a special kind of a pacemaker defibrillator that improves the contraction of the heart muscle and kind of makes it synchronous so that it decreases your heart failure episodes and actually might improve your morbidity and mortality.

We might implant a pacemaker defibrillator depending on your heart muscle.

So that's something to keep in mind.

Seventh, screen for and correct iron deficiency with intravenous iron and manage hyperkalemia and low blood pressure without abandoning prognostic drugs.

Eighth, ask the heart team about devices and procedures, CRT, ICD ablation, mitral or tricuspid intervention, and revascularization.

Ninth, make the transition home safe, euvolemia, a written plan, education, and follow up within seven to fourteen days, supported by monitoring linked to action.

And tenth, recognize advanced heart failure early with "I need help," refer in time, and involve palliative care alongside active treatment.

Because we now have new definition of heart failure with reduced ejection fraction, we have now different stages from A to E, and we have a new concept of foundational medical therapy.

We have MRAs recommended across the ejection fraction spectrum, and we have stronger recommendations around identifying causes for heart failure, structural intervention, CRT, amyloidosis, and advanced heart failure.

But none of that improves outcomes unless we actually implement it.

So today in the Beat Wise podcast, we're asking a slightly different questions.

Of course, we should all be open to randomizing our patients into trials.

I am a huge proponent of doing this, and I'm very proud of our robust commitment to the left versus left trial of CS pacing versus bivy pacing in CRT-eligible patients.

I'm so proud that we randomized patients into this non-industry-funded trial.

And I strongly believe that cardiologists are far too quick to reject equipoise.

All right.

Next trial is very interesting.

This is targeting CS leads in CRT devices.

This is the Danish CRT trial.

Implantable cardioverter defibrillator C.

A dual chamber pacemaker D. CRT pacemaker Or E.

A CRT defibrillator

Question 5

Which of the following is class 3 antiarrhythmic medication? Is it A.

So what is the correct answer?

I mean, it's a clear class one indication for an ICD implant.

The patient has a reduced ejection fraction heart failure with a narrow complex, therefore no CRT indication.